ORIGINAL ARTICLE Survival Outcome in Patients with Cardiomyopathy Detected by Gated SPECT Myocardial Perfusion Imaging Azmal Kabir Sarker 1,2 , Faria Nasreen 3 , Lutfun Nisa 3 , Raihan Hussain 4 , Harisul Hoque 5 and and Dipol K Adhikary 5 1 Institute of Nuclear Medicine & Allied Sciences, Mitford, SSMC campus, Dhaka, 1100. 2 Institute of Nuclear Medical Physics, AERE campus, Savar 3 National Institute of Nuclear Medicine & Allied Sciences, BAEC, Bangabandhu Sheikh Mujib Medical University campus, Shahbag, Dhaka, 1000. 4 Department of Nuclear Medicine, Apollo Hospitals, Plot 81, Block E, Bashundhara, Dhaka, 1229 5 Department of Cardiology, Bangabandhu Sheikh Mujib Medical University, Shahbag, Dhaka, 1000. Correspondence Address: Azmal Kabir Sarker, Institute of Nuclear Medicine & Allied Sciences, Mitford, Dhaka. Email aksninmas@gmail.com ABSTRACT Objectives: Quantitative assessment of LV dysfunction and viability through gated SPECT myocardial perfusion imaging (GSMPI) in addition to being diagnostic surrogate of cardiomyopathy (CM), are being increasingly reported as a predictor of adverse outcome in CM. This study was conducted to investigate the survival outcome in patients diagnosed with CM by GSMPI at National Institute of Nuclear Medicine & Allied Sciences (NINMAS). Patients and methods: Patients who underwent Tc-99m Sestamibi GSMPI at NINMAS from January 2007 to December 2009 and were diagnosed with CM were retrospectively included in the study. The GSMPI parameters of diagnosis of CM were a left ventricular ejection fraction (EF) at rest of less than 40% with a corresponding end diastolic left ventricular volume (EDV) of more than 130 ml. Telephonic interviews of those patients were conducted in the year 2015 to obtain their clinical follow up data. Results: Fifty two patients (M/F=50/2) were diagnosed to have CM over a period of three years. Follow up data of 19 (M/F=18/1) patients with mean age 52.9±7.4 (38-65), EF 29.1±6.6 (18-39), EDV 211±45.4 (135-320) were available. Nine (47.4%) patients were alive at the time of follow up and 10 (52.6%) patients were found to be deceased. Thus, in this patient group one and five year survival was estimated to be 68 and 47%. Comparison of means of pretest probability score, GSMPI parameters of LV function and viability revealed no difference (p > 0.05) between survivors and non-survivors. Test of equality of survival distributions for management strategies revealed no difference either (Log Rank significance, p > 0.05). Conclusions: Five year survival in this study group diagnosed with CM by GSMPI was 47% where pretest probability score, GSMPI parameters and management strategies were not associated with difference of survival. Key Words: Survival, cardiomyopathy, gated SPECT, myocardial perfusion, Bangladesh. Bangladesh J. Nucl. Med. Vol. 21 No. 2 July 2018 Doi: https://doi.org/10.3329/bjnm.v21i2.40356 INTRODUCTION Cardiomyopathy (CM) is characterized by left ventricular (LV) dilatation and LV systolic dysfunction (1) which progresses inexorably to heart failure (HF) (2, 3). CM, in advanced countries contributes up to 40% of the proportion of total patients with HF (4). Banerjee et al. reports HF in 75% patients and death during hospital stay in 8% patient with CM (5). HF causes decline in quality of life (6) with an observed 5-year survival of 26-52% (7) and thus it is labeled as more malignant that cancer (8). While HF is being increasingly detected in Asian countries reaching a prevalence of 1.5% (9), improved survival outcome is being reported with appropriate management (10, 11). LV ejection fraction (LVEF), end systolic volume (ESV), ESV index (ESVI) and LV scar percentage has been reported to be predictors of adverse outcome in CM (12-14). Gated SPECT myocardial perfusion imaging (GSMPI) with nitrate enhancement using Tc-99m Sestamibi is a validated technique for evaluation of LV dysfunction (15-17) as well as for prediction of survival outcome in patients with ischemic CM (18), and has been an associate to management of ischemic heart disease (IHD) in Bangladesh since 2001(19). To our best knowledge there is no report of survival rates among patients with severe LV dysfunction or CM in Bangladesh. Thus the aim of the study was to assess the long term survival outcome in patients after 81